SIDALAC 1 Satellite Meeting Resource Tracking and Priority Setting. XV International AIDS Conference Bangkok. 11 July, Methodological Approaches - Utility of National AIDS Accounts SIDALAC

FUNSALUD SIDALAC 2 To describe the financial flows identifying: -who pays -who benefits -through what mechanisms (reconstructing transactions from their sources to the end-up users) Objectives of NAA

FUNSALUD SIDALAC 3 Methods of the NAA  Estimation of all resources spent by calendar year in all kinds of activities from all sources  Description of sources of funding Domestic and International Public, Private  Description of agents or providers of services  Description of use of the resources Prevention vs. Care; and non-health Goods and services  Beneficiaries or target groups

FUNSALUD SIDALAC 4 Data collection Expenditures estimated from budgets Estimation of the actual costs of providing services and goods Classification of expenditures by International Classifications OECD Description of flows of financing Differentiation between budgets and executed expenditures Differentiation between donor perspective and actual flow into the country for HIV/AIDS activities Avoid of duplication of expenditures by describing flows

FUNSALUD SIDALAC 5 Detail by subprograms Access to ARV Vertical Prevention Blood Banks IDU Prevention

FUNSALUD SIDALAC 6 Identification of the expenditure explicitly directed to the most vulnerable populations and the highest risk for HIV MSM CSW (men and women) Social marketing of condoms Inmates Mobile Populations General Population (youngsters, women)

FUNSALUD SIDALAC 7 Categories of Expenditure (examples) Public Health: Epi Surveillance, IEC Prevention: Condoms, STI’s Tx, MTCT Prevention, Needles, Blood Banks Treatment: Hospitalary, Ambulatory Support Services: Diagnostic Tests, Monitoring of ARV therapy –viral load, CD4+ Cell counts. Anti-retrovirals Other drugs: Prophylaxis, Treatment of OI

FUNSALUD SIDALAC 8 Public Expenditures in HIV/AIDS as Percentage of National HIV/AIDS Expenditures in LAC Regional Average 73.8%

FUNSALUD SIDALAC 9 EXPENDITURE ON HIV/AIDS IN LAC TOTAL EXPENDITURE (Million USD): US$1,225.3 Public Sources: US$ (73.8%) Private Sources:US$ (24.0%) External Sources:US$ 26.3 ( 2.1%)

FUNSALUD SIDALAC 10 Total HIV/AIDS Expenditures LAC and Two West African countries. Adjusted by PPP- USD$, 2002.

FUNSALUD SIDALAC 11 Main Expenditure Items in LAC CARE (70% of total Expenditure) Total Expenditure on Care US$ 800,845,217 Main Item ARV 65% Expenditure per capita $1.65 PREVENTION (27% of Total Expenditure) Total Expenditure in Prevention and Public Health US$ 309,221,436 Main Item CONDOMS 58% Total per capita $0.64 NON-HEALTH ACTIVITIES (3%) Total Non-Health Expenditure US$37,582,037 Main Item TRAINING 72% (e.g. conferences)

FUNSALUD SIDALAC 12 FUNSALUD SIDALAC ONUSIDA Total HIV/AIDS Expenditures by Functions, Burkina Faso, 2003 Personal Health Care services 26% Equipment 2% Non-Health or health related expenditures 23% Administration 15% Prevention and Public Health 34%

FUNSALUD SIDALAC 13

FUNSALUD SIDALAC 14 HIV/AIDS Expenditures by source and by target population, e.g. Belize, 2003.

FUNSALUD SIDALAC 15 Expenditure in Functions by Source in 13 LAC countries, Percentage of the total expenditure SOURCE (% of the Total) Care (75.2%) PREV. (18.2%) ADMN. (4.6%) INVEST (0.2%) NON- HEALTH (1.8%) PUBLIC (83.6%) PRIVATE (14.8%) INTERNATIONAL ( 1.6%) Total expenditure = USD$ 588,550,000

FUNSALUD SIDALAC 16 Expenditure in Functions by Source in two West African countries, Percentage of the total expenditure SOURCE (% of the Total) CARE (17.9%) PREV. (36.7%) ADMIN. (9.2%) INVEST. (1.9%) NON- HEALTH (33.3%) PUBLIC (33.3%) PRIVATE (10.8%) INTERNATIONAL ( 55.9%) Total expenditure = USD$ 51,858,000

FUNSALUD SIDALAC 17 Per capita public and private expenditure in HIV/AIDS, USD$ R 2 = Public US$ per capita Private US$ per capita GUY URU ARG MEX CHI CSR PAN BEL ELS COLBOL VEN PAR NIC GH03 GH BF03

FUNSALUD SIDALAC 18 Expenditure per PLWHA versus GDP per capita (US$) in thirteen selected LAC countries, 2001

SIDALAC 19 Country examples of the utility of NAA

FUNSALUD SIDALAC 20 Expenditure in Prevention and Care. BRAZIL (million $USD) A saving in care; an increase in prevention YEAR USD$ PreventionTreatment and care

FUNSALUD SIDALAC 21 HIV/AIDS Expenditures in prevention and care. MEXICO (Million USD$) Sharper increase in care; moderate increase for prevention.

FUNSALUD SIDALAC 22 Preventive expenditure on MSM and the percentage of AIDS cases among MSM Lack of correlation between epidemiogical information and expenditure in the population at highest risk Argentina Bolivia Brazil Chile Costa Rica Dominican R El Salvador Guatemala Mexico Panama Paraguay Peru Uruguay Preventive Expenditure on MSMAIDS Cases among MSM %

FUNSALUD SIDALAC 23 HIV/AIDS Expenditures in Local Currency. Ghana, Additionality of GFATM 0 20,000 40,000 60,000 80, ,000 Ministry of Health Other Central Government NGO’s Households (OOPE) Multilaterals (Including GFATM) Bilaterals International NGOs PUBLICPRIVATEINTERNATIONAL CEDIS

FUNSALUD SIDALAC 24 Resources according to source of information NAA Level of expenditure according to NAA

FUNSALUD SIDALAC 25 Resources according to source of information NSP Costing of National Strategic Plan

FUNSALUD SIDALAC 26 Comparison between level of Resources according to source of information: NAA and NSP NAA NSP

FUNSALUD SIDALAC 27 Comparison of results from NAA and from NSP Non essential expenditure NEEDS OF NEW RESOURCES Irreducible exp. NAA NSP =  Eliminate expenditure  Add to NSP

FUNSALUD SIDALAC 28 CHALLENGES Need of capacity building /capacity strengthening Continue with capacity building in countries already involved in resource tracking and initiate process in other countries/regions Instead of experts producing hardly-repeatable case studies, promote country officials conduct their own estimates; Transformation into a continuous information system instead of cross-sectional estimates Need of sufficient financial resources to conduct projects and training in developing countries

SIDALAC 29